Provider Demographics
NPI:1548407141
Name:SHAMBLIN, ALICIA C (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 S WAYNE RD
Mailing Address - Street 2:APEX BEHAVIORAL HEALTH
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:734-405-0185
Practice Address - Street 1:1547 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:734-405-0185
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2018-02-08
Deactivation Date:2017-08-29
Deactivation Code:
Reactivation Date:2018-02-08
Provider Licenses
StateLicense IDTaxonomies
OHI0700402101YM0800X
MI68010916421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health